Implementation of the European Laryngological Society classification for pediatric benign laryngotracheal stenosis: a multicentric study

Ivana Fiz, Philippe Monnier, Jan Constantin Koelmel, Diana Di Dio, Michele Torre, Francesco Fiz, Francesco Missale, Cesare Piazza, Giorgio Peretti, Christian Sittel

Research output: Contribution to journalArticlepeer-review


PURPOSE: The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes.

METHODS: We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I-IV according to Myer-Cotton grading system), number of subsites involved ("a" to "d" for 1-4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity ("+" sign). We analyzed the ability of this scoring system in predicting the rates of decannulation and complications, as well as the number of re-treatments.

RESULTS: The mean decannulation rate was 88%; a higher rate was observed in patients without comorbidities (95.7% vs. 78.1%, p < 0.001), with two or fewer vs. three or four subsites involved (89% vs. 72%, p < 0.01), and in those with an ELS score of IIIa+ or less vs. patients with IIIb or more (96% vs. 82%, p < 0.001). Surgical complications were not dependent on the degree of stenosis, but rather on the number of affected subsites (p < 0.05), as well as on the presence of associated comorbidities (RR 7.5, p < 0.01). The number of re-treatments was dependent on length of resection (p < 0.05), stage according to the revised ELS classification (p < 0.001), and presence of surgical complications (RR 17, p < 0.001).

CONCLUSIONS: The revised ELS classification system is easy to apply in everyday practice and offers a sound contribution in the decision-making process.

Original languageEnglish
Pages (from-to)785-792
Number of pages8
JournalEuropean Archives of Oto-Rhino-Laryngology
Issue number3
Publication statusPublished - Mar 2019


  • Child
  • Constriction, Pathologic
  • Decision Making
  • Device Removal
  • Europe
  • Female
  • Humans
  • Laryngostenosis/classification
  • Male
  • Reproducibility of Results
  • Retrospective Studies
  • Societies, Medical
  • Tracheal Stenosis/classification
  • Treatment Outcome


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